Understanding CTS Treatment Options

For mild to moderate carpal tunnel syndrome, therapy provides equal or better patient outcomes compared to surgery with no pain killers, significantly reduced risks, faster recovery, and vastly lower patient cost-of-care.

For many people with CTS, conservative therapy relieves symptoms and restores function - without the use of dangerous drugs or risky surgeries. Non-surgical therapy is universally recognized as the first-line CTS treatment modality. The AAOR cautions that surgery should be used only as a last resort advising that surgery is only appropriate for severe cases that interfere with daily life with symptoms lasting over 6 months where non-surgical intervention has not resolved the issue.

Chiropractors are experts at restoring wellness by treating the root cause of CTS with hands-on care and patient education without risks associated with surgery.

Symptoms typically include tingling, pain, numbness or weakness in the fingers and thumb. Some patients may also experience radiating pain in the forearm.

Dr. Dukes usually resolves CTS within a few weeks through therapeutic, non-surgical therapy. Many patients start feeling better after the first treatment. Symptoms normally improve gradually. Within a few weeks, most patients report significantly reduced pain, tingling and numbness as well as normal hand function.

• Women get carpal tunnel syndrome three times more often than men.
• Carpal tunnel syndrome is a progressive condition that can worsen without proper care.
• CTS symptoms often present during pregnancy and can be alleviated with nonsurgical treatments. Symptoms often improve after delivery, but such patients are at higher risk of developing carpal tunnel syndrome later in life.
• Most people first experience symptoms in their dominant hand.

What is Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is typically a constriction of the median nerve as it runs through the carpal tunnel in your wrist. The root cause is most often irritation or damage that causes inflammation with use which compresses the carpal tunnel on your medial nerve.

Symptoms of this common hand condition include numbness and/or tingling exhibiting in the thumb and fingers which often results in pain, discomfort, weakness and reduced mobility over time.

The carpal tunnel is a narrow passageway through your wrist. It is made of tendons, ligaments and bones located on the anterior (palm) side of your hand. It protects the median nerve and allows it to pass through your wrist and into your hand.

The median nerve provides sensory feeling to your thumb, index finger, middle finger and the thumb side of the ring finger and controls motor (movement) functions to the forearm, wrist and hand. It also sends touch, pain and temperature sensations from the lower arm and hand to the brain.

Better Patient Outcomes: Therapy VS Surgery

Research shows that, in most cases, non-surgical therapy provides equal to or better outcomes when compared to carpal tunnel surgery. In fact, the American Academy of Orthopedic Surgeons (AAOS) recommends non-surgical therapy as the primary CTS treatment modality and cautions that surgery should be used only as a last resort further advising that surgery should be recommended only if ALL of the following criteria are met:

1. Severe symptoms present for at least 6 months. 60% of patients carpal tunnel symptoms resolve on their own with rest. For 40% of patients, symptoms will last for months and intensify without intervention.
2. Symptoms are so severe they interfere with daily life. Symptoms typically advance within 6-12 months of the first symptoms. Severe symptoms may include weakness and radiating pain that limits dexterity and functionality.
3. All nonsurgical remedies were tried without success. The vast majority of patients typically experience complete relief using non-surgical therapies to treat CTS.
   
   

Research published in the Journal of Orthopaedic & Sports Physical Therapy revealed that at the 3, 6, and 12 month post-treatment follow-up examinations, patients in both the therapy and surgery groups showed similar improvements in function and grip strength. Pain also decreased similarly for patients in both groups. The researchers concluded that therapy and surgery for carpal tunnel syndrome yield similar patient benefits.

What to Expect from Non-Surgical Carpal Tunnel Therapy

In most cases, non-surgical therapy treatment is effective in reducing CTS symptoms and often helps patients get back to everyday activities within 8-12 weeks depending upon the symptom severity.
Typically patients are referred by their primary care physician or a hand specialist after a examination results in a CTS diagnosis. Patients may also self-refer to avoid delaying the process and mitigate cost of care.

Therapy for mild cases of early-stage CTS typically involves an initial consultation, testing and 1-2 therapy sessions over 4 weeks. Treatment may include: 

• Resting the affected hand and wrist. 
• Avoiding activities that may worsen symptoms.
• Education on proper workplace rest breaks, ergonomics, on-the-job stretching and light exercises. 
• Immobilizing the wrist in a splint to avoid further damage from twisting or bending – especially while sleeping.
• Applying cool packs to help reduce swelling from inflammation.
• Inflammation and swelling treatment through PEMF and/or Cymatic Therapy.

Patients with moderate or severe CTS treatment begin with the same process used to treat mild CTS symptoms along with specialized therapy techniques such as myofascial release or fascial stretch therapies that gently manipulate the joints and soft tissues of the wrist, hand, and arm releasing restrictions and tissue adhesions to alleviate pressure on the median nerve. These techniques reduce symptoms and improve electromyographic test results by naturally releasing the transverse carpal ligament which "opens" or dilates the canal. People on blood thinners, with metabolic conditions, deep vein thrombosis, open wounds, burns or bone fractures are not candidates for myofascial therapy.

Myofascial release is the primary treatment modality used to break-up restrictions and tissue adhesions in and around the tendons inside the wrist joint. Specifically, this technique breaks fascia restrictions and adhesions that cause tendon inflammation and swelling. This inflammation and swelling is the underlying condition that causes carpal tunnel symptoms. 
Two primary techniques used:

• Friction: This is a glide technique that involves applying pressure to the base of the wrist with both thumbs and then gliding the thumbs toward the elbow with sustained pressure to break up tissue adhesions.
• Petrissage: Utilizes movements like kneading, wringing, skin-rolling, and deep squeezing to help stretch and loosen tight muscles that may be contributing to CTS.

After myofascial release therapy, you may feel soreness. This should go away within 12-24 hours and your arm, wrist and hand should feel more relaxed.
Fascial stretch therapy is another type of manual therapy where therapists don’t apply pressure to certain areas of your body. Instead, parts of your body (such as your arms and hands) are manually moved to stretch your fascial tissues.

Treatment may be recommended every one to three days over several weeks or a few months. Therapy sessions will last 15 to 50 minutes.  Session frequency and intensity will depend on the cause and severity of your condition. Most patients report numbness and pain subsiding within 12 weeks.
Once your symptoms have subsided, your practitioner will likely prescribe self-care stretching, strengthening exercises, and wearing a splint at night until full hand strength returns. Length of time required for full strength to return varies by patient, but most can expect complete recovery in 6 months. Patients should consider:

• Risk. Because therapy is non-invasive and drug-free, there are few risks. Short-term soreness is the most common risk. Rare cases of myofascial release causing internal bleeding, nerve damage and/or short-term paralysis have been reported.
• Complications. Ineffective or incomplete release resulting in recurrence. In severe (Stage 4) cases not responding to therapeutic approaches, an assessment for surgical intervention may be indicated.
• Cost. Therapy provides affordable, first-line treatment of CTS symptoms.

• Recovery. Most patients report symptom resolution within 12 weeks.
• Return to work time. Most patients choosing non-surgical therapy to treat CTS return to normal activity within 8 weeks of treatment.

What to Expect from Carpal Tunnel Surgery

While each patient’s experience is unique, in most cases the process takes 16-24 weeks from the initial PCP appointment, specialist consultation, surgery and primary recovery. Full recovery may take 4-12 months depending.

In most cases patients are referred to a hand specialist after a general exam performed by their primary physician indicates the potential for CTS.  A specialist provider will normally use a combination of physical and imaging tests to diagnose your condition. These may include: Tinel’s sign, Phalen’s test, Wrist X-rays, Electromyography (EMG), Ultrasound, and/or Magnetic resonance imaging (MRI).
Surgery for carpal tunnel syndrome is usually done as an outpatient procedure using local or general anesthesia. Two types of carpal tunnel surgery are typically performed:

Open surgery involves the surgeon making an approximately 2-inch long cut on the wrist, then cutting the carpal ligament to make the carpal tunnel passageway larger.

Endoscopic surgery is performed with the surgeon making one half-inch long cut on the wrist. Then a small probe is attached to a narrow tube which is then inserted into the cut. The small probe may or may not have a camera. The surgeon inserts surgical instruments through the narrow tube and cuts the carpal ligament through the other incision. The surgeon uses the camera to locate and cut the carpal ligament. When there is no camera, an ultrasound device guides the surgeon to the correct probe placement before cutting the carpal ligament.

Post CTS Surgery

Post-operative care can be intensive for some patients and mild for others. After surgery, your hand and wrist will be splinted for several weeks or more. The surgeon may also have you keep the affected hand elevated above your heart while sleeping at night to decrease swelling. You'll likely begin a physical therapy program once the stitches have healed and the splint is removed. Use of a splint or brace may be recommended for 4-6 weeks after surgery.

Risks. Carpal tunnel release surgery potential risks include bleeding, infection, injury to the median nerve or nerves that branch out from it, injury to nearby blood vessels, sensitive scaring, the need for more surgery.

Potential complications. According to a 2023 NIH report,” the most frequent complication of carpal tunnel surgery is the development of a neuroma in the palmar cutaneous branch of the median nerve. Patients may also experience hypertrophic scars, joint stiffness, dysesthesias, and incomplete resolution of their symptoms.”

Cost considerations. According to the NIH, the median cost of carpal tunnel surgery was $10,273 as of April 2023. The estimate does not include pre-surgery examinations, testing, post-surgery care, therapy nor follow-up examination costs.

Recovery time. Carpal tunnel surgery recovery time varies. Most patients report numbness and pain subsiding within 4 months. Hand strength will return within 1 year – how much strength returns can vary.

Pain medication. Prescription pain-killers and drugs are typically prescribed to control post-surgery pain and inflammation.

Return to work time. Surgery recovery takes longer for a significant number of patients. The majority of patients choosing therapy to treat CTS return to normal activity within 8 weeks of treatment. However, over 30% of CTS patients choosing surgery do not return to work within 8 weeks.

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Causes, Risk Factors and Prevention

Overuse from repetitive strain injuries is the most common cause of CTS.

• Frequent, repetitive movements with the hands.
• Extending or flexing the wrist for long periods of time.
• Inflammation in the joints.
• Rheumatoid arthritis and other related conditions.
• Hormonal or metabolic changes (menopause, pregnancy or thyroid imbalance, etc.).
• Wrist anatomy/scar tissue from previous injuries.
• Poor health due to smoking, obesity and/or poor nutrition.
• Nerve damage from diabetes, high-blood pressure, etc.
• Health conditions such as Gout, Hypothyroidism, Amyloidosis, or Rheumatoid arthritis.
  

It can be hard to prevent carpal tunnel syndrome, especially with a contributing health condition or activities contributing to the condition cannot be avoided. Professional healthcare associations including The American Chiropractic Association and the American Academy of Orthopedic Surgeons suggest the following CTS prevention strategies: 

• Stop smoking.
• Maintain a healthy weight and fitness level.
• Eat healthy, nutritious food. Avoid processed, high-sodium foods.
• Stretch your wrists and hands before and after intense physical activities.
• Wear proper protective equipment for all work or activities.
• Take frequent rest breaks when working with your hands.
• Perform on-the-job conditioning, such as stretching and light exercises. 
• Use correct posture and wrist position. 
• Use proper workplace ergonomics.
• Wear splints to help keep the wrists straight – especially at night. 
  

Call to Action

Patient education is key to positive patient outcomes. We hope that this article arms those suffering from CTS with the facts they need to make informed health conditions.

Early diagnosis, treatment and intervention will help avoid more extensive damage as well as improve healing trajectory.

If you've been told that drugs or surgery are your only options, Dr. Dukes encourages you to learn the facts and get a second opinion. Dr. Dukes can help get you back to living life on you terms, naturally.

Call ​​(813) 752-2524 today to schedule your consultation with Dr. Dukes.